Recommendation for Depression Screening

Depression– second leading cause of cancer-related deaths in the US

  • Lifetime risk is 12% for men and 26% for women.1
  • Depression is more than just a periodic feeling that we get from having a bad day; it is the persistence of a “blue” mood or somatic symptoms that can be a warning signal.
  • Suicide is the 7th leading cause of death in the US. 70% of suicides see their primary care practitioner within 6 weeks of suicide.

Who should be screened?

  • Anyone who is concerned that they may be exhibiting signs and symptoms of depression.
  • Anyone with continuous somatic complaints (expressing a mental condition as a disturbed bodily function) of physical illness or pain without response to medical intervention.
  • Risk factors include:1
  • female gender (especially postpartum)
  • history of depressive illness in first-degree relatives (parents, siblings)
  • prior episodes of major depression
  • prior suicide attempts
  • medical comorbidity
  • decreased social support
  • stressful life events
  • current substance or alcohol abuse

When to seek medical advice

  • If a person is expressing thoughts of harm to self or others, they should seek immediate medical attention immediately.

Useful Sites and Resources

  • National Institute of Mental Health, 5600 Fishers Ln, Room 10-85, Rockville, MD 20857; (800)421-4211.
  • Internet address:
  • National Mental Health Association, 1021 Prince St, Alexandria, VA 22314; (800)969-6642.

References

  1. Abreu AC & Filips JK: Psychiatry: Mood disorders. Major Depressive Disorder. In: Anon: University of Iowa Family Practice Handbook, chapter 18, 4th ed. Available online at: (cited 10/23/02).
  2. Anon: Screening for Mental Health, inc. website. Available at: (cited 10/23/02).
  3. Forest Hills Medical Associates, Inc: The Zung self-rating depression scale. Available at: (cited 10/24/02)
  4. Zung self-rating depression scale. At: Afraid to ask website. Available at: (cited 10/24/02)

DSM-IV Criteria for the Diagnosis of Depression1

Depression DSM-IV criteria for a major depressive episode* include at least five of the following symptoms present for at least 2 weeks that represent a change from previous level of functioning.
  • Depressed mood (most of day, almost daily). Note: In children and adolescents there may be an irritable mood
  • Diminished interest or pleasure in all or most activities
  • Significant weight loss or gain or decrease or increase in appetite nearly every day
/
  • Insomnia or hypersomnia
  • Psychomotor retardation or agitation (observable by others)
  • Fatigue or decreased level of energy
  • Feelings of worthlessness or inappropriate guilt
  • Poor concentration or indecisiveness
  • Recurrent thoughts of death or suicidal ideation

Note: At least one of the symptoms must be either (1) depressed mood or (2) loss of interest or pleasure.
*To be defined as a major depressive episode, the symptoms (1) must cause clinically significant distress or impairment in functioning and (2) must not be attributable to the effects of substance use, general medical condition, or bereavement.

The following lists the diagnostic criteria for depression, and any patient experiencing at least five of the following symptoms for at least 2 weeks should seek medical attention for depression:

Screening

  • October 10 is national depression screening day
  • Many on-line depression screening tools are available, but in-person screening is desirable.
  • Asking two simple question from the PRIME MD is a quick and validated screening process: During the past two weeks have you felt down, depressed or hopeless or have you experienced little interest or pleasure in doing things?
  • The Beck depression scale is the gold standard and can be administered by a healthcare professional.
  • The Zung self-rating depression scale is completed by the patient and can be used as a screening too. To use the Zung scale and determine if your symptoms warrant medical attention, go to the following website where your test can be taken and scored:
  • You can also go to and click on the link to take the same Zung self-rating depression scale.